慢性阻塞性肺疾病合并肺动脉高压对左心室收缩和舒张功能的影响。
Impact of chronic obstructive pulmonary disease with pulmonary hypertension on both left ventricular systolic and diastolic performance.
作者信息
Yilmaz Remzi, Gencer Mehmet, Ceylan Erkan, Demirbag Recep
机构信息
Department of Cardiology, Faculty of Medicine, Harran University, Sanliurfa, Turkey.
出版信息
J Am Soc Echocardiogr. 2005 Aug;18(8):873-81. doi: 10.1016/j.echo.2005.01.016.
BACKGROUND
The effects of chronic obstructive pulmonary disease (COPD) on right ventricular (RV) systolic and diastolic functions and left ventricular (LV) diastolic function have been shown. Whereas LV myocardial performance index (LVMPI), which incorporates ejection and isovolumic relaxation and contraction times and is an index of global ventricular function, has not yet been evaluated in COPD.
METHODS
Our study population consisted of 24 age-matched control subjects (group 1), 24 patients with COPD without pulmonary hypertension (group 2), and 20 patients with COPD with pulmonary hypertension (group 3). Pulmonary function tests, analyses of arterial blood gases, and transthoracic echocardiographic examination were performed. RV myocardial performance index (RVMPI) and LVMPI were obtained by pulsed wave Doppler tissue.
RESULTS
RVMPI was higher in both group 2 (0.61 +/- 0.15) and group 3 (0.94 +/- 0.27) than group 1 (0.41 +/- 0.08) (P = .038 and P< .001, respectively), and was higher for group 3 than in group 2 (P = .018). LVMPI was higher for group 3 (0.77 +/- 0.25) than in both group 1 (0.49 +/- 0.08) and group 2 (0.59 +/- 0.10) (P = .001 and P = .037, respectively). However, difference between groups 1 and 2 was not significant (P > .05). For patients with COPD, LVMPI was positively correlated with age, heart rate, pulmonary arterial systolic pressure, RVMPI, and partial pressure of carbon dioxide, and negatively correlated with tricuspid annular plane systolic excursion, forced expiratory volume in 1 second, and partial pressure of oxygen. In multiple linear regression analysis (R2 = 0.676), LVMPI was independently associated with forced expiratory volume in 1 second (Beta = 0.549, P = .017), pulmonary arterial systolic pressure (Beta = 0.488, P = .014), and RVMPI (Beta = 0.278, P = .042).
CONCLUSIONS
Both LV systolic and diastolic functions are impaired in COPD, especially in patients with pulmonary hypertension. This impairment is independently associated with pulmonary arterial systolic pressure, RVMPI, and forced expiratory volume in 1 second.
背景
慢性阻塞性肺疾病（COPD）对右心室（RV）收缩和舒张功能以及左心室（LV）舒张功能的影响已得到证实。然而，左心室心肌性能指数（LVMPI），它综合了射血、等容舒张和收缩时间，是整体心室功能的一个指标，尚未在COPD患者中进行评估。
方法
我们的研究对象包括24名年龄匹配的对照者（第1组）、24名无肺动脉高压的COPD患者（第2组）和20名有肺动脉高压的COPD患者（第3组）。进行了肺功能测试、动脉血气分析和经胸超声心动图检查。通过脉冲波多普勒组织成像获得右心室心肌性能指数（RVMPI）和左心室心肌性能指数（LVMPI）。
结果
第2组（0.61±0.15）和第3组（0.94±0.27）的RVMPI均高于第1组（0.41±0.08）（P分别为0.038和P<0.001），且第3组高于第2组（P = 0.018）。第3组（0.77±0.25）的LVMPI高于第1组（0.49±0.08）和第2组（0.59±0.10）（P分别为0.001和P = 0.037）。然而，第1组和第2组之间的差异不显著（P>0.05）。对于COPD患者，LVMPI与年龄、心率、肺动脉收缩压、RVMPI和二氧化碳分压呈正相关，与三尖瓣环平面收缩期位移、第1秒用力呼气量和氧分压呈负相关。在多元线性回归分析（R2 = 0.676）中，LVMPI与第1秒用力呼气量（β = 0.549，P = 0.017）、肺动脉收缩压（β = 0.488，P = 0.014）和RVMPI（β = 0.278，P = 0.042）独立相关。
结论
COPD患者的左心室收缩和舒张功能均受损，尤其是合并肺动脉高压的患者。这种损害与肺动脉收缩压、RVMPI和第1秒用力呼气量独立相关。
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